Sinus Rate in Acute Myocardial Infarction

Total Page:16

File Type:pdf, Size:1020Kb

Sinus Rate in Acute Myocardial Infarction Br Heart J: first published as 10.1136/hrt.34.9.901 on 1 September 1972. Downloaded from British Heart Journal, I972, 34, 901-904. Sinus rate in acute myocardial infarction R. M. Norris, C. J. Mercer, and S. E. Yeates From Green Lane Hospital, Auckland, New Zealand The clinical course of sinus bradycardia and sinus tachycardia has been studied in 735 patients owith acute myocardial infarction admitted to a coronary care unit. Sinus bradycardia was con- sidered to have occurred when two or more records showed sinus rhythm with a rate below 6o a minute, and sinus tachycardia when a sinus rate over 0OO a minute occurred in two or more records. Hospital mortality of patients having sinus bradycardia was significantly lower (6%) and of those with sinus tachycardia was significantly higher (26%) than of those who had neither bradycardia nor tachycardia (i5%). Major ventricular arrhythmias were no more common in patients having sinus bradycardia and when they did occur did not usually do so at the time ,'that the bradycardia was present. Sinus bradycardia was more common in cases ofposterior and subendocardial infarction without radiological evidence of cardiac failure, while sinus tachy- cardia was frequent in patients with anterior transmural infarction complicated by heartfailure. The benign course of sinus bradycardia is surprising because experimental evidence suggests that slow heart rates after infarction favour the occurrence of ventricular arrhythmias. Further work is necessary to correlate heart rate with prognosis, particularly in patients seen at the onset ,.f infarction, and before admission to a coronary care unit. Observations of patients in coronary care clinical and experimental evidence, and to units has shown that wide variations in sinus suggest that further studies on the association rate occur in patients who have suffered acute of bradyarrhythmias with ventricular fibrilla- http://heart.bmj.com/ myocardial infarction. Sinus tachycardia has tion are necessary under a wider variety of been found to be associated with a high mor- clinical conditions. lrality, while sinus bradycardia has in general een found to be benign and not associated with serious complications (Lawrie et al., Patients and methods I967; Jewitt et al., I967; Chapman, I97I). Patients were all those admitted to the four- Experiments on dogs (Han et al., i966a, b; bedded coronary-care unit at Green Lane Hos- Han, i969), however, have shown that slow pital over three years. Myocardial infarction was on October 1, 2021 by guest. Protected copyright. heart rates after infarction favour the occur- considered to have occurred if two or more of the rence of ventricular arrhythmias, and on this following criteria were satisfied: (i) Characteristic account aggressive treatment of bradycardia clinical presentation; (2) pathological Q waves, ST elevation, or T wave inversion in the electro- - favoured by some (Lown et al., I967; cardiogram with evolutionary changes; and (3) Gregory and Grace, I968). Moreover, as rise in serum aspartate aminotransferase (SGOT) sinus bradycardia occurs most commonly at to over 40 units/ml. Patients over 70 years of age the onset of infarction before most patients were in general excluded because of shortage of come under medical attention, it has been beds, 53 per cent of patients were admitted within 0 suggested that sinus bradycardia occurring six hours of onset of the most severe chest pain, early after the onset may have a more serious and stay in the unit was three days on average. *ignificance than when the arrhythmia occurs Ten-second electrocardiograms were made later (Adgey et al., i968, I971; Stock, I97I). hourly or whenever an arrhythmia occurred, and The purpose of this paper is to pre- clinical data with details of arrhythmias were re- amplify corded on punch cards (International Business vious observations (Norris, I969a; Norris and Machines). Sinus bradycardia was considered to Mercer, I970) on the benign course of sinus have occurred if two or more records showed sinus bradycardia as seen in a coronary care unit, rhythm with a rate below 6o a minute. In order to draw attention to the conflict between the to study possible effects or associations of sinus bradycardia with prognosis and with other Received 2I December I971. arrhythmias, the findings were compared with Br Heart J: first published as 10.1136/hrt.34.9.901 on 1 September 1972. Downloaded from go2 Norris, Mercer, and Yeates those in patients who had sinus tachycardia (two TABLE I Sinus tachycardia and sinus or more records with a sinus rate over Ioo a bradycardia complicating acute myocardial minute), those who had both sinus bradycardia infarction - incidence, mortality, and and sinus tachycardia and those who had neither of these arrhythmias. Cases of sinus bradycardia association with major ventricular arrhythmias were also examined in relation to the lowest re- Sinus Sinus Sinus Neither sinus corded heart rate, the time of occurrence after bradycardia tachycardia bradycardia bradycardia ' admission to the coronary care unit, and the site and sinus nor sinus of infarction and degree of cardiac failure assessed tachycardia tachycardia from the electrocardiogram and chest x-ray. No. of cases 152 267 41 275 Per cent of total 2I 36 6 37 Results Mortality 9 (6%) 70 (26%) 9 (22%) 42 (15%/o) No. having major ven- During the three years, I223 patients were tricular arrhythmias 39 (26%) 87 (33%) I5 (37%) 64 (23%) admitted to the coronary care unit and, of No. having ventricular I these, 735 had acute myocardial infarction fibrillation II (7%) 29 (II%) 4 (I0%) 20 (7%) according to the above criteria, and were un- selected cases, not referred from other hos- pitals. Of these 735 patients, i52 (2i%) had was between 50 and 6o a minute, in 30 per sinus bradycardia, 267 (36%) had sinus tachy- cent the rate was 40 to 50 a minute, while in cardia, 4I (6%) had both sinus bradycardia I0 per cent of cases it was less than 40 a and tachycardia, and 275 (37%) had neither minute, often with alternation between sinus arrhythmia (Table I). Hospital mortality was nodal significantly lower (6%; P<o-oi) in and pacemakers. Patients in the latter X2=8'i, group usually had an abrupt onset of brady- patients who had sinus bradycardia, and sig- cardia accompanied by faintness, pallor, and nificantly greater (26%; X2=999, P<o-oi) in These attacks those who had sinus tachycardia, when these hypotension. responded promptly to intravenous atropine 0-3 to o-6 groups of patients were compared with those mg, but in several cases when there was an who had neither (mortality i 5%). The incidence of ventricular fibrillation and inadvertent delay in giving atropine there was a spontaneous improvement in heart rate. Of major ventricular arrhythmias in the same I3 patients in whom sinus bradycardia at a groups of patients is also shown in Table i. rate of less than 40 a minute was observed, Major ventricular arrhythmias were classified only one had major ventricular arrhythmias as as salvoes of two or more ventricular ectopic http://heart.bmj.com/ beats, ventricular ectopic beats showing the described above, and none had ventricular fibrillation. The possibility that some cases of R on T phenomenon, ventricular tachycardia, and ventricular fibrillation. We have found sinus bradycardia were due to therapy was also considered, and in 8 cases it was possible the first three of these arrhythmias to be asso- that alprenolol, which was the subject of a ciated with a significantly increased incidence of ventricular fibrillation (R. M. Norris, I968, clinical trial (Briant and Norris, I970), was the cause of the arrhythmia. In some other unpublished observations). There was no patients morphine may have caused the brady- difference in the incidence of ven- significant cardia, particularly when vomiting occurred on October 1, 2021 by guest. Protected copyright. tricular arrhythmias among any of the groups, after giving the drug. though there was a tendency for patients with The relation of sinus bradycardia and sinus sinus tachycardia to have a higher incidence of major ventricular arrhythmias and ventricular tachycardia to the site and extent of infarction fibrillation. Of the ii patients who had both sinus bradycardia and ventricular fibrillation, 7 had ventricular fibrillation while they were TABLE 2 Relation between site and extent of being observed in the coronary care unit. In infarction and occurrence of sinus bradycardia all of these patients ventricular fibrillation and tachycardia l occurred at a time when sinus bradycardia was not present. Moreover, ventricular fibril- Anterior Anterior Posterior Posteriort lation and major ventricular arrhythmias were trans- subendo- trans- subendo- no more common when sinus bradycardia mural cardial mural cardial occurred within one hour of admission Sinus bradycardia I0% 24% 31% 36% (approximately 5o% of cases) than when it Sinus tachycardia 52% 24% 29% 30% occurred later. Sinus bradycardia and sinus c Further analysis of the cases of sinus brady- tachycardia 6% 5% 6% 2% Neither sinus bradycardia nor cardia showed that in approximately 6o per sinus tachycardia 32% 47% 34% 32% M cent of cases the lowest recorded heart rate Br Heart J: first published as 10.1136/hrt.34.9.901 on 1 September 1972. Downloaded from Sinus rate in acute myocardial infarction 903 TABLE 3 Relation between sinus bradycardia slow heart rates favour the occurrence of and tachycardia and occurrence of radiological arrhythmias due to re-entry or spontaneous pulmonary oedema discharge of excitable myocardial cells (Han et al., I966a, b; Han, i969), and the clinical IL No. of No. having evidence that 'over driving' the heart at a cases oedema faster rate can suppress ventricular arrhyth- Sinus bradycardia 58 7 (I2%) mias (Sowton, Leatham, and Carson, i964). Sinus tachycardia I15 53 (46%) The mechanisms of asynchronous repolariza- Sinus bradycardia and sinus tion and spontaneous depolarization of myo- tachycardia I9 7 (37%) Neither sinus bradycardia cardial cells which have been described would nor sinus tachycardia io8 34 (32%) presumably also operate in bradyarrhythmia due to atrioventricular block.
Recommended publications
  • Common Arrhythmias Disclosures
    Common Arrhythmias Disclosures • I work for Virginia Garcia Memorial Health Center. • And I am a medical editor for Jones & Bartlett Publishing. Jon Tardiff, BS, PA-C OHSU Clinical Assistant Professor What a 12-Lead ECG can help you do • Diagnose ACS / AMI • Interpret arrhythmias • Identify life-threatening syndromes (WPW, LGL, Long QT synd., Wellens synd., etc) • Infer electrolyte imbalances • Infer hypertrophy of any chamber • Infer COPD, pericarditis, drug effects, and more! Arabic, Somali, Mai Mai, Pashtu, Urdu, ASL, and more! For example… WPW with Atrial Fib 55 66 Wolff-Parkinson-WhiteWPW Graphic synd. Same pt, converted to SR Drs. Wolff, Parkinson, & White 77 Another example: Dr. William Stokes—1800s 71 y.o. man with syncope This patient is conscious and alert! Third Degree Block 9 Treatment: permanent pacemaker 10 Lots of ways to read ECGs… Limitations of a 12-Lead ECG • QRSs wide or narrow? • Is it sinus rhythm or not? • Truly useful only ~40% of the time • Regular or irregular? • If not, is it atrial fibrillation? • Each ECG is only a 10 sec. snapshot • Fast or slow? • BBB? • P waves? • MI? • Serial ECGs are necessary, especially for ACS • Other labs help corroborate ECG findings (cardiac markers, Cx X-ray) • Confounders must be ruled out (LBBB, dissecting aneurysm, pericarditis, WPW, Symptoms: digoxin, LVH, RVH) • Syncope is bradycardia, heart blocks, or VT • Rapid heart beat is AF, SVT, or VT Conduction System Lead II P wave axis …upright in L II II R T P R U Q S …upright in L II R wave axis SA Node AV Node His Bundle BBs Purkinje Fibers 14 13 Q S Normal Sinus Rhythm Triplicate Method: 6-second strip: 6 seconds 300, 150, 100, Count PQRST cycles in a 6 75, 60, 50 second strip & multiply x 10 Quick, easy, sufficient Easy, & more accurate 300 150 100 75 60 6 seconds What is the heart rate? Horizontal axis is time (mS); vertical axis is electrical energy (mV) 16 1.
    [Show full text]
  • Unstable Angina with Tachycardia: Clinical and Therapeutic Implications
    Unstable angina with tachycardia: Clinical and therapeutic implications We prospectively evaluated 19 patients with prolonged chest pain not evolving to myocardiai infarction and accompanied with reversible ST-T changes and tachycardia (heart rate >lOO beats/min) in order to correlate heart rate reduction with ischemic electrocardiographic (ECG) changes. Fourteen patients (74%) received previous long-term combined treatment with nifedipine and nitrates. Continuous ECG monitoring was carried out until heart rate reduction and at least one of the following occurred: (1) relief of pain or (2) resolution of ischemic ECG changes. The study protocol consisted of carotid massage in three patients (IS%), intravenous propranolol in seven patients (37%), slow intravenous amiodarone infusion in two patients (lo%), and intravenous verapamil in four patients (21%) with atrial fibrillation. In three patients (16%) we observed a spontaneous heart rate reduction on admission. Patients responded with heart rate reduction from a mean of 126 + 10.4 beats/min to 64 k 7.5 beats/min (p < 0.005) and an ST segment shift of 4.3 k 2.13 mm to 0.89 k 0.74 mm (p < 0.005) within a mean interval of 13.2 + 12.7 minutes. Fifteen (79%) had complete response and the other four (21%) had partial relief of pain. A significant direct correlation was observed for heart rate reduction and ST segment deviation (depression or elevation) (f = 0.7527 and 0.8739, respectively). These patients represent a unique subgroup of unstable angina, in which the mechanism responsible for ischemia is excessive increase in heart rate. Conventional vasodilator therapy may be deleterious, and heart rate reduction Is mandatory.
    [Show full text]
  • Cardiovascular Disease and Rehab
    EXERCISE AND CARDIOVASCULAR ! CARDIOVASCULAR DISEASE Exercise plays a significant role in the prevention and rehabilitation of cardiovascular diseases. High blood pressure, high cholesterol, diabetes and obesity can all be positively affected by an appropriate and regular exercise program which in turn benefits cardiovascular health. Cardiovascular disease can come in many forms including: Acute coronary syndromes (coronary artery disease), myocardial ischemia, myocardial infarction (MI), Peripheral artery disease and more. Exercise can improve cardiovascular endurance and can improve overall quality of life. If you have had a cardiac event and are ready to start an appropriate exercise plan, Cardiac Rehabilitation may be the best option for you. Please call 317-745-3580 (Danville Hospital campus), 317-718-2454 (YMCA Avon campus) or 317-456-9058 (Brownsburg Hospital campus) for more information. SAFETY PRECAUTIONS • Ask your healthcare team which activities are most appropriate for you. • If prescribed nitroglycerine, always carry it with you especially during exercise and take all other medications as prescribed. • Start slow and gradually progress. If active before event, fitness levels may be significantly lower – listen to your body. A longer cool down may reduce complications. • Stop exercising immediately if you experience chest pain, fatigue, or labored breathing. • Avoid exercising in extreme weather conditions. • Drink plenty of water before, during, and after exercise. • Wear a medical identification bracelet, necklace, or ID tag in case of emergency. • Wear proper fitting shoes and socks, and check feet after exercise. STANDARD GUIDELINES F – 3-5 days a week. Include low weight resistance training 2 days/week I – 40-80% of exercise capacity using the heart rate reserve (HRR) (220-age=HRmax; HRmax-HRrest = HRR) T – 20-60mins/session, may start with sessions of 5-15 mins if necessary T – Large rhythmic muscle group activities that are low impact (walking, swimming, biking) Get wellness tips to keep YOU healthy at HENDRICKS.ORG/SOCIAL..
    [Show full text]
  • Respiration Driven Excessive Sinus Tachycardia Treated with Clonidine Matthew Emile Li Kam Wa,1 Patricia Taraborrelli,1 Sajad Hayat,2 Phang Boon Lim1
    Novel treatment (new drug/intervention; established drug/procedure in new situation) BMJ Case Reports: first published as 10.1136/bcr-2016-216818 on 28 April 2017. Downloaded from CASE REPORT Respiration driven excessive sinus tachycardia treated with clonidine Matthew Emile Li Kam Wa,1 Patricia Taraborrelli,1 Sajad Hayat,2 Phang Boon Lim1 1Department of Cardiology, SUMMARY no evidence of dual AV node physiology, accessory Imperial College Healthcare A 26-year-old man presented to our syncope service pathway or inducible supraventricular tachycardia. NHS Trust, London, UK 2Department of Cardiology, with debilitating daily palpitations, shortness of breath, A subsequent permanent pacemaker led to no University Hospitals Coventry presyncope and syncope following a severe viral further episodes of frank syncope. However his and Warwickshire NHS Trust, respiratory illness 4 years previously. Mobitz type II block ongoing debilitating exertional and respiratory- Coventry, UK had previously been identified, leading to a permanent driven palpitations with presyncope remained. pacemaker and no further episodes of frank syncope. Conservative measures including increased fluid Correspondence to Dr Phang Boon Lim, Transthoracic echocardiography, electophysiological study intake and compression stockings had no effect. [email protected] and repeated urine metanepherines were normal. His Trials of medication including fludrocortisone, fle- palpitations and presyncope were reproducible on deep cainide, β blockers and ivabradine were either not Accepted 18 December 2016 inspiration, coughing, isometric hand exercise and tolerated or had no significant effect on his passive leg raises. We demonstrated rapid increases in symptoms. heart rate with no change in morphology on his 12 lead During a simple active stand over 3 min, his ECG.
    [Show full text]
  • Myocardial Infarction (Heart Attack)
    Sacramento Heart & Vascular Medical Associates February 19, 2012 500 University Ave. Sacramento, CA 95825 Page 1 916-830-2000 Fax: 916-830-2001 Patient Information For: Only A Test Myocardial Infarction (Heart Attack) What is a myocardial infarction (MI)? Myocardial infarction (MI) is a heart attack. It happens when blood flow to a part of the heart is suddenly blocked. How does it occur? Myocardial infarction may occur at any time and often occurs without warning. As we grow older, our coronary arteries may become narrowed by the buildup of cholesterol plaque. When the arteries narrow, less blood can go through them, and less oxygen gets to the heart muscle. The process of narrowing is called atherosclerosis. The narrower the artery becomes, the more likely it is that a blood clot may form and block the artery completely, causing a heart attack. Sometimes sudden blockages can occur even in places where the artery was not narrow before. A heart attack may also occur when the heart muscle needs more oxygen than the blood vessels can provide. This might happen, for example, during hard exercise such as shoveling snow, or with a sudden increase in blood pressure. Less commonly, a heart attack can occur due to coronary spasm. Coronary spasm is a sudden and temporary narrowing of a small part of an artery that supplies blood to the heart. It may be caused by smoking or drugs such as cocaine. Risk factors for heart disease include: - cigarette smoking - a family history of heart attack - diabetes - overweight - high blood pressure - high blood cholesterol - low HDL cholesterol (that is, too little "good" cholesterol) - stress - a lifestyle that does not include much physical activity.
    [Show full text]
  • Basic Rhythm Recognition
    Electrocardiographic Interpretation Basic Rhythm Recognition William Brady, MD Department of Emergency Medicine Cardiac Rhythms Anatomy of a Rhythm Strip A Review of the Electrical System Intrinsic Pacemakers Cells These cells have property known as “Automaticity”— means they can spontaneously depolarize. Sinus Node Primary pacemaker Fires at a rate of 60-100 bpm AV Junction Fires at a rate of 40-60 bpm Ventricular (Purkinje Fibers) Less than 40 bpm What’s Normal P Wave Atrial Depolarization PR Interval (Normal 0.12-0.20) Beginning of the P to onset of QRS QRS Ventricular Depolarization QRS Interval (Normal <0.10) Period (or length of time) it takes for the ventricles to depolarize The Key to Success… …A systematic approach! Rate Rhythm P Waves PR Interval P and QRS Correlation QRS Rate Pacemaker A rather ill patient……… Very apparent inferolateral STEMI……with less apparent complete heart block RATE . Fast vs Slow . QRS Width Narrow QRS Wide QRS Narrow QRS Wide QRS Tachycardia Tachycardia Bradycardia Bradycardia Regular Irregular Regular Irregular Sinus Brady Idioventricular A-Fib / Flutter Bradycardia w/ BBB Sinus Tach A-Fib VT PVT Junctional 2 AVB / II PSVT A-Flutter SVT aberrant A-Fib 1 AVB 3 AVB A-Flutter MAT 2 AVB / I or II PAT PAT 3 AVB ST PAC / PVC Stability Hypotension / hypoperfusion Altered mental status Chest pain – Coronary ischemic Dyspnea – Pulmonary edema Sinus Rhythm Sinus Rhythm P Wave PR Interval QRS Rate Rhythm Pacemaker Comment . Before . Constant, . Rate 60-100 . Regular . SA Node Upright in each QRS regular . Interval =/< leads I, II, . Look . Interval .12- .10 & III alike .20 Conduction Image reference: Cardionetics/ http://www.cardionetics.com/docs/healthcr/ecg/arrhy/0100_bd.htm Sinus Pause A delay of activation within the atria for a period between 1.7 and 3 seconds A palpitation is likely to be felt by the patient as the sinus beat following the pause may be a heavy beat.
    [Show full text]
  • The Management of Acute Coronary Syndromes in Patients Presenting
    CONCISE GUIDANCE Clinical Medicine 2021 Vol 21, No 2: e206–11 The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician Authors: Ramesh NadarajahA and Chris GaleB There have been significant advances in the diagnosis and international decline in mortality rates.2,3 In September 2020, management of non-ST-segment elevation myocardial the European Society of Cardiology (ESC) published updated infarction over recent years, which has been reflected in an Clinical Practice Guidelines for the management of ACS in patients international decline in mortality rates. This article provides an presenting without persistent ST-segment elevation,4 5 years after overview of the 2020 European Society of Cardiology Clinical the last iteration. ABSTRACT Practice Guidelines for the topic, concentrating on areas relevant The guidelines stipulate a number of updated recommendations to the general or emergency physician. The recommendations (supplementary material S1). The strength of a recommendation and underlying evidence basis are analysed in three key and level of evidence used to justify it are weighted and graded areas: diagnosis (the recommendation to use high sensitivity according to predefined scales (Table 1). This focused review troponin and how to apply it), pathways (the recommendation provides learning points derived from the guidelines in areas to facilitate early invasive coronary angiography to improve relevant to general and emergency physicians, including diagnosis outcomes and shorten hospital stays) and treatment (a (recommendation to use high sensitivity troponin), pathways paradigm shift in the use of early intensive platelet inhibition).
    [Show full text]
  • Treatment of Acute Coronary Syndrome
    Acute Coronary Syndrome: Current Treatment TIMOTHY L. SWITAJ, MD, U.S. Army Medical Department Center and School, Fort Sam Houston, Texas SCOTT R. CHRISTENSEN, MD, Martin Army Community Hospital Family Medicine Residency Program, Fort Benning, Georgia DEAN M. BREWER, DO, Guthrie Ambulatory Health Care Clinic, Fort Drum, New York Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States. Family physicians need to identify and mitigate risk factors early, as well as recognize and respond to acute coronary syn- drome events quickly in any clinical setting. Diagnosis can be made based on patient history, symptoms, electrocardi- ography findings, and cardiac biomarkers, which delineate between ST elevation myocardial infarction and non–ST elevation acute coronary syndrome. Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. Coupled with appropriate medical management, percutaneous coronary interven- tion can improve short- and long-term outcomes following myocardial infarction. If percutaneous coronary interven- tion cannot be performed rapidly, patients with ST elevation myocardial infarction can be treated with fibrinolytic therapy. Fibrinolysis is not recommended in patients with non–ST elevation acute coronary syndrome; therefore, these patients should be treated with medical management if they are at low risk of coronary events or if percutaneous coronary intervention cannot be performed. Post–myocardial infarction care should
    [Show full text]
  • Basic Cardiac Rhythms – Identification and Response Module 1 ANATOMY, PHYSIOLOGY, & ELECTRICAL CONDUCTION Objectives
    Basic Cardiac Rhythms – Identification and Response Module 1 ANATOMY, PHYSIOLOGY, & ELECTRICAL CONDUCTION Objectives ▪ Describe the normal cardiac anatomy and physiology and normal electrical conduction through the heart. ▪ Identify and relate waveforms to the cardiac cycle. Cardiac Anatomy ▪ 2 upper chambers ▪ Right and left atria ▪ 2 lower chambers ▪ Right and left ventricle ▪ 2 Atrioventricular valves (Mitral & Tricuspid) ▪ Open with ventricular diastole ▪ Close with ventricular systole ▪ 2 Semilunar Valves (Aortic & Pulmonic) ▪ Open with ventricular systole ▪ Open with ventricular diastole The Cardiovascular System ▪ Pulmonary Circulation ▪ Unoxygenated – right side of the heart ▪ Systemic Circulation ▪ Oxygenated – left side of the heart Anatomy Coronary Arteries How The Heart Works Anatomy Coronary Arteries ▪ 2 major vessels of the coronary circulation ▪ Left main coronary artery ▪ Left anterior descending and circumflex branches ▪ Right main coronary artery ▪ The left and right coronary arteries originate at the base of the aorta from openings called the coronary ostia behind the aortic valve leaflets. Physiology Blood Flow Unoxygenated blood flows from inferior and superior vena cava Right Atrium Tricuspid Valve Right Ventricle Pulmonic Valve Lungs Through Pulmonary system Physiology Blood Flow Oxygenated blood flows from the pulmonary veins Left Atrium Mitral Valve Left Ventricle Aortic Valve Systemic Circulation ▪ Blood Flow Through The Heart ▪ Cardiology Rap Physiology ▪ Cardiac cycle ▪ Represents the actual time sequence between
    [Show full text]
  • Acute Non-Specific Pericarditis R
    Postgrad Med J: first published as 10.1136/pgmj.43.502.534 on 1 August 1967. Downloaded from Postgrad. med. J. (August 1967) 43, 534-538. CURRENT SURVEY Acute non-specific pericarditis R. G. GOLD * M.B., B.S., M.RA.C.P., M.R.C.P. Senior Registrar, Cardiac Department, Brompton Hospital, London, S.W.3 Incidence neck, to either flank and frequently through to the Acute non-specific pericarditis (acute benign back. Occasionally pain is experienced on swallow- pericarditis; acute idiopathic pericarditis) has been ing (McGuire et al., 1954) and this was the pre- recognized for over 100 years (Christian, 1951). In senting symptom in one of our own patients. Mild 1942 Barnes & Burchell described fourteen cases attacks of premonitory chest pain may occur up to of the condition and since then several series of 4 weeks before the main onset of symptoms cases have been published (Krook, 1954; Scherl, (Martin, 1966). Malaise is very common, and is 1956; Swan, 1960; Martin, 1966; Logue & often severe and accompanied by listlessness and Wendkos, 1948). depression. The latter symptom is especially com- Until recently Swan's (1960) series of fourteen mon in patients suffering multiple relapses or patients was the largest collection of cases in this prolonged attacks, but is only partly related to the country. In 1966 Martin was able to collect most length of the illness and fluctuates markedly from of his nineteen cases within 1 year in a 550-bed day to day with the patient's general condition. hospital. The disease is thus by no means rare and Tachycardia occurs in almost every patient at warrants greater attention than has previously some stage of the illness.
    [Show full text]
  • Recurrent Takotsubo Cardiomyopathy: a Rare Diagnosis with a Common Emergency Department Presentation Emily M Miner, Harini Gurram, Tennie Renkens and Julie L
    Case Report iMedPub Journals ARCHIVES OF MEDICINE 2017 http://www.imedpub.com/ Vol.9 No.4:8 ISSN 1989-5216 DOI: 10.21767/1989-5216.1000229 Recurrent Takotsubo Cardiomyopathy: A Rare Diagnosis with a Common Emergency Department Presentation Emily M Miner, Harini Gurram, Tennie Renkens and Julie L. Welch* Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA *Corresponding author: Julie L Welch, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA, Tel: 317-962-8880; E-mail: [email protected] Received date: August 08, 2017; Accepted date: August 14, 2017; Published date: August 16, 2017 Citation: Miner EM, Gurram H, Renkens T, Welch JL. Recurrent Takotsubo Cardiomyopathy: A Rare Diagnosis with a Common Emergency Department Presentation. Arch Med. 2017, 9:4 Copyright: © 2017 Miner EM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The incidence of recurrent Takotsubo cardiomyopathy after initial diagnosis is about 5% at 6 years with recurrence being Abstract more common when the initial episode has more severe left ventricular dysfunction [4]. While the long-term prognosis of Takotsubo cardiomyopathy is a non-ischemic Takotsubo is favorable in >95% of cases, acute symptoms of an cardiomyopathy that is often triggered by a physical or episode can be life-threatening and lead to cardiogenic shock emotional stressor and commonly affects post-menopausal [5]. Proper diagnosis is crucial in these life-threatening women. A 57 year old female with a significant past medical history for atrial fibrillation, anxiety, and Takotsubo situations.
    [Show full text]
  • Inappropriate Sinus Tachycardia Following Viral Illness
    Case Report Inappropriate Sinus Tachycardia Following Viral Illness Khalid Sawalha 1,* , Fuad Habash 2 , Srikanth Vallurupalli 2 and Hakan Paydak 3 1 Internal Medicine Division, White River Health System, Batesville, AR 72501, USA 2 Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; [email protected] (F.H.); [email protected] (S.V.) 3 Electrophysiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-984-364-1158 Abstract: A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycar- dia with no other abnormality. Laboratory findings, along with imaging, showed normal results. The event monitor failed to detect any arrythmias. We report a case of inappropriate sinus tachycardia secondary to viral infection as a diagnosis of exclusion. Keywords: inappropriate sinus tachycardia; viral infection; palpitations 1. Introduction Inappropriate sinus tachycardia, also called chronic non-paroxysmal sinus tachycardia, is an unusual condition that occurs in individuals without apparent heart disease or other cause of sinus tachycardia, such as hyperthyroidism or fever, and is generally considered a diagnosis of exclusion [1–4]. Inappropriate sinus tachycardia is defined as a resting heart Citation: Sawalha, K.; Habash, F.; rate >100 beats per minute associated with highly symptomatic palpitations [5,6]. Vallurupalli, S.; Paydak, H. Commonly used criteria to define inappropriate sinus tachycardia include [7] P-wave Inappropriate Sinus Tachycardia axis and morphology similar to sinus rhythm, and a resting heart rate of 100 beats per Following Viral Illness.
    [Show full text]